Medicine and Health Sciences Commons^™

Covid: The Sound Of Silence, Saptarshi Biswas

HCA Healthcare Journal of Medicine

COVID brought its toll of deaths. Something the human race has not experienced in recent times. Something almost unimaginable in the modern world! But having joined a new hospital and moved to a sleepy old town, COVID gave me a sense of solitude I have not experienced for eons. There are times you wonder at the endless ocean in front of you and communicate with your inner soul.

And Yet, Angelina Hong

HCA Healthcare Journal of Medicine

As healthcare workers, invested in the wellbeing of our patients while also hoping to grow as individuals, we sometimes tend to view our jobs as a rigid duality—we are either “in love” with our practice and persevere flawlessly through all hardship, or we are “burnt out,” coldhearted, and defeated by the heavy workload and expectations of medicine.

In reality, we all sit somewhere in the middle of a blurry spectrum, balancing out physical, mental, and emotional pain with the immense honor of saving and cherishing human life, while simultaneously struggling to reconcile our altruistic goals with realistic but necessary human …

Disabilities And Medicine: From Stairs To Stares, Christopher Denham

HCA Healthcare Journal of Medicine

The current state of medicine has done little to correct the imbalance of underrepresented groups in the physician workforce. In this editorial, a psychiatric resident physician retells his experience as an individual who is completing his medical training while being affected by a neuromuscular disorder and how it impacts his daily life. The primary goal of this paper is to elucidate the need for greater representation and understanding of the disabled physician workforce.

Eruptive Sebaceous Hyperplasia: A Case Report And Review Of The Literature, Carsten Z. Steinmetz, Amanda Getz, Andras Schaffer, Stephen K. Richardson

HCA Healthcare Journal of Medicine

Introduction

Eruptive sebaceous hyperplasia (ESH) is a benign process characterized by the acute onset and rapid proliferation of sebaceous glands, typically on the face. Although historically attributed to cyclosporine therapy, the preponderance of reports over the past 2 decades suggests a more complex etiology. There is increasing thought a combination of multiple medications as well as a genetic component contribute to ESH’s clinical presentation. Despite these theories, the exact cause of ESH in immunosuppressive therapy is poorly understood.

Case Presentation

To our knowledge, we report the third case of ESH arising in multimodality immunosuppressive therapy, consisting of tacrolimus, mycophenolate mofetil, …

Acute Esophageal Necrosis And Duodenal Disease In The Setting Of Recently Initiated Chemotherapy, Kulveer Dabb, Ryan Jansen Van Rensburg, Heba Yusuf, Daniel Klein, Alexander D. Lake, Mohamed Kaif

HCA Healthcare Journal of Medicine

Introduction

Acute esophageal necrosis (AEN), commonly referred to as “black esophagus” or Gurvits syndrome, is a rare condition characterized by diffuse black mucosa in the distal esophagus. Most often, the patient is an older male with multiple comorbidities, presenting with upper gastrointestinal bleeding. The exact pathogenesis is unclear, but it is often thought to be secondary to acute vascular hypo-perfusion or ischemia of the esophageal mucosa in critically ill patients with certain secondary comorbid conditions such as renal insufficiency, diabetes mellitus, dyslipidemia, coronary artery disease, malnourishment, alcohol abuse, or association with an underlying malignancy.

Case Presentation

We present a case …

How Did That Get There? A Case Series Of Adolescent Foreign Bodies, Justin Ian Hanson, Paul Bomar, Sarah Kleist, Denver Rogalla, Lori Crihfield, Scott Gutovitz

HCA Healthcare Journal of Medicine

Introduction

Pediatric foreign bodies (FBs) come in many shapes and sizes, and the method by which they enter the body can greatly impact the level of acuity at presentation. Most FBs in children are found in those younger than 5 years old, but the following 3 cases were found in adolescent patients.

Case Presentation

We report on 3 adolescent patients who presented to a single community-based emergency department with the chief complaint of abdominal pain and were found to have complications of abdominal FBs. If undiagnosed, the initial indolent courses of FBs can lead to serious complications, as shown in …

Who Left The Hospital Against Medical Advice During The Early Covid-19 Pandemic?, Bryan Werner, Se Won Lee

HCA Healthcare Journal of Medicine

Background

Patients leaving against medical advice (AMA) presents a challenge to hospitals as they try to manage costs and improve patient outcomes in an ever-increasing competitive market. Investigating AMA discharges that occurred during the early COVID-19 pandemic presents a unique opportunity to better understand this phenomenon and be better prepared for the future.

Methods

This retrospective analysis of 34 379 patients from a nationwide private healthcare system across 20 states analyzed patients during the early stages of the pandemic who chose to leave against medical advice (AMA) after being admitted with COVID-19 infection and identified several patient characteristics associated with …

An Unusual Presentation Of Infective Endocarditis, Ethan J. Peterson, Jordan Jackson, Syed M. Zaidi, Jorge Perez

HCA Healthcare Journal of Medicine

Introduction

Leukocytoclastic vasculitis is the inflammation of small blood vessels due to leukocyte migration that comprises a wide range of differentials. It can be caused by autoimmune disorders, infections, neoplasms, or certain medications and warrants prompt recognition and therapy for optimal patient outcomes.

Case Presentation

Here we present a case of a 37-year-old male who presented with a painful, petechial rash on his torso and extremities. Skin biopsy revealed leukocytoclastic vasculitis, thereby prompting a comprehensive investigation into the underlying etiology leading to the diagnosis of Pseudomonas aeruginosa infective endocarditis.

Conclusion

Pseudomonas aeruginosa is a rare cause of infective endocarditis with …

Covid-19 Disease Characterization And Outcomes Comparison In Pediatrics, Rachel Rowland, Abigail Schauble, Brendon Cornett

HCA Healthcare Journal of Medicine

Background

It has been reported that children experience less severe COVID-19 symptoms than adults; however, the literature that supports this idea is evolving. The purpose of this study was to retrospectively characterize hospitalized COVID-19-positive pediatric patients with a focus on the assessment of risk factors for poorer outcomes, mortality, and evaluation of interventions utilized and associated clinical outcomes.

Methods

We conducted a multi-center retrospective chart review of patients 18 years old or younger who were COVID-19 positive and admitted to any US HCA Healthcare Pediatric service line between January 1, 2020, and November 30, 2020. We identified 6081 children across …

Video Documentation As A Measure Of Written Documentation Accuracy In Emergency Medical Service Field Intubations, Christopher S. Keller, Christopher Dilger, Shih-Chin Chou, Rasheed Lawal, Shane Jenks

HCA Healthcare Journal of Medicine

Introduction

Quality improvement (QI) is a major focus of all departments and fields of health care, including emergency medical services. The chaotic and rapidly evolving atmosphere in which paramedics must practice can lead to inconsistency between what is documented and the actual events. This leads to difficulty when trying to evaluate the practitioners and when implementing a QI program. In this study, we evaluated the prevalence of discrepancy between the video and written record for Rapid Sequence Intubation (RSI) performed in the field as a demonstration of the utility of video documentation in QI.

Methods

We used a systematic retrospective …

Fascial Defect Closure During Ventral Hernia Repair: A Systematic Review Of Randomized Controlled Trials, Shin Jeong, Tunmi A. Anwoju, Oscar A. Olavarria, Natalia Cavagnaro, Naila H. Dhanani, Nicole B. Lyons, Zuhair Ali, Mike K. Liang

HCA Healthcare Journal of Medicine

Background

During minimally invasive ventral hernia repair (VHR) it is unknown if a fascial defect closure, as opposed to a bridged repair (current care), is beneficial for patients. We sought to systematically review the published literature on the role of fascial defect closure during minimally invasive VHR.

Methods

PubMed, Embase, Scopus, Cochrane, and Clinicaltrials.gov were reviewed for randomized controlled trials (RCTs) that compared fascial defect closure with bridged repair. The primary outcome was major complications defined as deep/organ-space surgical site infections (SSIs), reoperations, hernia recurrences, or deaths. Secondary outcomes included SSI, seroma, eventration, hernia recurrence, post-operative pain, and quality of …

An Acknowledgement To The Hca Healthcare Journal Of Medicine's Reviewers And Editors For The First Half Of 2023, Bruce Deighton, Hossein Akhondi, Barbara L. Gracious, David Scott Lind, Graig Donini

HCA Healthcare Journal of Medicine

The HCA Healthcare Journal of Medicine would like to thank those behind the scenes who make this publication possible. Our journal would not be possible without the assistance of our peer reviewers, authors, and board members. We also announce our inclusion in PubMed Central.

Medical School Watercooler Newsletter - August 31, 2023, Lindsey Lyle

Watercooler Newsletter

This is the August 31, 2023 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents include:

• More than 200 books donated in memory of pediatrician Cindy Sheets, M.D.
• Internal medicine residents place fourth in academic competition
• Meet a Med Student: Anthony Fant
• IDEAMED exposes local youth to careers in medicine

Computational And Experimental Investigation Of Elemental Sulfur And Polysulfide, Jyoti Sharma

Dissertations

Petroleum processing results in the generation of significant quantities of elemental sulfur (S₈), leading to a surplus of sulfur worldwide. Despite its abundance and low cost, the use of sulfur in value-added organic compound synthesis is limited due to its unpredictable and misunderstood reactivity. This dissertation aims to address this issue by tackling it from two angles. Firstly, by utilizing Density Functional Theory (DFT) calculations, the reactivity of sulfur in the presence of nucleophiles is studied. This facilitates the identification of organic polysulfide intermediates that can be generated under different conditions, as well as the corresponding reactivity for …

Bertumbuh Berkembang: Modul Pemberian Makan Bayi Dan Anak (Pmba), Hikmah Kurniasari

Pengembangan Profesional

Pemberian Makanan Bayi dan Anak (PMBA) yang optimal akan meningkatkan kesempatan hidup dan pertumbuhan anak; juga daya tangkap untuk menguasai keterampilan serta pengetahuan yang mereka perlukan sebelum memulai pendidikan di tahun-tahun awal sekolah. Tidak hanya bagi bayi dan anak, pemenuhan gizi yang baik juga amat penting bagi ibu hamil dan menyusui. Selain penjelasan lengkap seputar PMBA dan kesehatan ibu hamil/menyusui, modul ini juga menjelaskan kepercayaan lokal yang kepercayaan lokal yang terkadang menimbulkan misinformasi dan menghambat akses bagi ibu, bayi, dan anak untuk mendapatkan nutrisi yang dibutuhkan. Modul ini akan bermanfaat bagi kader layanan kesehatan (Posyandu) untuk menyampaikan informasi yang tepat …

The Noloco Strategy For Essential Hypertension, F. Matthew Mihelic Md

Faculty Publications

Ninety-nine percent of all “essential” hypertension can be controlled by using the NoLoCo strategy, without causing any significant side-effects and without an increase in insulin resistance. NoLoCo stands for Norvasc (amlodipine), Lozol (indapamide), and Cozaar (losartan), but the medicines are considered and used in reverse order.

Environmental Isolate Developing Antibiotic Resistance By Complementation, Mary Ridgeway, Ashley Fink, David Mitchell

Biology Faculty Publications

Antibiotic resistance is a growing concern within the scientific community. With few new antibiotics being introduced and an increasing number of resistant microbes, routine bacterial infections are becoming more difficult to treat in clinics and hospitals. The purpose of this study is to compare the ability of two environmental isolates – Staphylococcus aureus (S. aureus) and Exiguobacterium undae (E. undae) to grow in solutions of increasing concentrations of tetracycline and ciprofloxacin. After the bacteria showed grow in the solutions, antibiotic susceptibility was tested by examining zones of inhibition on Trypticase Soy Agar (TSA) plates. Our results …

Comparison Of Prevalence And Associated Factors Of Multisystem Health Symptoms Among Workers In The Gas Station Area, Thailand, Chan Pattama Polyong, Anamai Thetkathuek

Kesmas

This cross-sectional study aimed to compare the prevalence of multisystem health symptoms (MHS) of workers in gas station areas before and after their employment and examine the factors affecting the MHS of workers. Data were collected by an interview questionnaire from 200 workers inside and outside refueling areas at eight gas stations in Rayong Province, Thailand. This study found that employees had a statistically significant increase in the prevalence of current MHS in comparison to before starting work (p-value<0.05), with 31.5%. Working overtime for more than 6 hours per week led to respiratory symptoms (OR = 2.63, 95% CI = 1.14–6.07) and psychological symptoms (OR = 2.69, 95% CI = 1.12–6.49). Wearing respiratory protective equipment for less than three hours affected ear/throat/nose systems (OR = 4.26, 95% CI = 1.43–12.65). Petrol refueling resulted in liver (OR = 2.32, 95% CI = 1.4–12.65) and eye symptoms (OR = 2.57, 95% CI = 1.10–5.39). Therefore, gas station owners should set up enclosed rooms to reduce the duration of fuel exposure, and workers should wear personal protective equipment when refueling or near the dispenser.

Workload And Stress Level In Non-Covid-19 Zoning Nurses At National Central Public Hospital Jakarta, Zakiyah Zakiyah, Ulfah Nuraini Karim, Aliana Dewi, Siti Nuraini, Aan Sutandi, Rony Darmawansyah Alnur

Kesmas

The COVID-19 pandemic has increased the workload for nurses directly handling COVID-19 patients and those working in non-COVID-19 zones. As the number of COVID-19 cases rises, nurses face psychological problems, including stress. This study aimed to determine the relationship between workload and stress levels in a non-COVID-19 zoning ward using a cross-sectional approach and Spearman’s correlation test conducted on 94 nurses at one hospital in Jakarta, Indonesia, selected through simple random sampling. The workload questionnaire with 15 items and the DASS 42 questionnaire were used to measure stress levels. The results indicated that most nurses (73.4%) experienced a heavy workload. …

Engaging Patients In Opioid Use Disorder Treatment: A Mixed Methods Study Investigating Primary Care Team Perspectives On Approaches, Barriers, And Facilitators, Elizabeth J. Austin, Ulrich Koch, Monica S. Ruiz, Anna D. Ratzliff, Emily C. Williams, Yavar Moghimi

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Harms from opioid use disorder (OUD) cause significant morbidity and mortality, responsible for over 107,000 overdose-related deaths in 2022 and igniting an urgency to expand access to OUD-related care to new settings such as primary care. A critical element of successful OUD care is engaging patients throughout the OUD care continuum and ongoing retention, yet OUD care engagement rates in outpatient settings are hugely variable, ranging from 4%-70% for initial (14-30 day) treatment engagement, and markedly diminishing over time. The barriers that patients cite to engagement point to the need to deliver more patient-centered OUD care, yet little …

Major Factors Influencing The Utilization Of Maternal Health Services In Nepal, Kaitlyn Alessi, Michael Ierardi, Nadia Anderson, Sujan Babu Marahatta, Cyril Blavo

HPD Articles

According to the World Health Organization, maternal health services (MHS) include antenatal care, perinatal care, and postnatal care. MHS have been underutilized in Nepal and are contributing to an increased morbidity and mortality in the region leading to various adverse outcomes for both mothers and their newborns. Many of these adverse outcomes can be avoided with increased use of antenatal, perinatal, and postnatal checkups.

A Membrane-Associated Mhc-I Inhibitory Axis For Cancer Immune Evasion, Xufeng Chen, Qiao Lu, Hua Zhou, Jia Liu, Bettina Nadorp, Audrey Lasry, Zhengxi Sun, Baoling Lai, Gergely Rona, Jiangyan Zhang, Michael Cammer, Kun Wang, Wafa Al-Santli, Zoe Ciantra, Qianjin Guo, Jia You, Debrup Sengupta, Ahmad Boukhris, Hongbing Zhang, Cheng Liu, Peter Cresswell, Patricia L M Dahia, Michele Pagano, Iannis Aifantis, Jun Wang

Faculty, Staff and Student Publications

Immune-checkpoint blockade has revolutionized cancer treatment, but some cancers such as acute myeloid leukemia (AML) do not respond or develop resistance. A potential mode of resistance is immune evasion of T-cell immunity involving aberrant MHC-I antigen presentation (AP). To map such mechanisms of resistance, we identified key MHC-I regulators using specific peptide-MHC-I-guided CRISPR/Cas9 screens in AML. The top-ranked negative regulators were surface protein Sushi Domain Containing 6 (SUSD6), Transmembrane Protein 127 (TMEM127), and the E3 ubiquitin ligase WWP2. SUSD6 is abundantly expressed in AML and multiple solid cancers, and its ablation enhanced MHC-I AP and reduced tumor growth in CD8+ …

Knowledge, Awareness, And Perceived Barriers Regarding Cervical Cancer Screening Among Bangladeshi Women Suffering From Cervical Cancer: A Cross-Sectional Study, Muhammed Mohibul Islam, Farhana Sultana, Md Hasan Shahriar Rahman, Nandita Islam Pia, Md. Al Hasibuzzaman, Arman Ahmed, Mohammed Shamim Hasan, Md Kayes Mahmud, Rabeya Akter, Md. Saqline Mostaq, Mohammad Nurul Amin

Makara Journal of Health Research

Background: This study aimed to evaluate the knowledge, awareness, and perceived barriers regarding cervical cancer screening among women in Bangladesh.

Methods: A hospital-based survey was conducted from January to April 2021 among 200 female participants. Statistical analysis of this study was performed by using Stata 13 (StataCorp LP, 4905 Lakeway Drive, College Station, TX 77845, USA), where Chi-square test was used for the determination of the correlation among different variables.

Results: Among the participants, 86.5% were rural residents, 96% were married, 87.5% were housewives, 47% were uneducated, and 93.5% lived on a husband’s income. Moreover, 84.5% hadn’t …

Solid Lipid Nanoparticles (Sln): Formulation And Fabrication, Gabriella F. Punu, Yahdiana Harahap, Qonita Kurnia Anjani, Pietradewi Hartrianti, Ryan F. Donnelly, Delly Ramadon

Pharmaceutical Sciences and Research

Solid lipid nanoparticles (SLN) have emerged as a novel drug delivery system and have been utilized for delivering various kinds of drugs since the 1990s. These particles may consist of multiple solid lipids, including glycerides, waxes, and fatty acids, and can be stabilized by a wide range of surfactants. SLN have garnered significant attention from researchers due to its innovative and versatile nature. Moreover, such delivery system has numerous advantages over traditional colloidal carriers, such as liposomes, polymeric nanoparticles, and emulsions. Several research groups have been developing SLN formulations and fabrication techniques based on their intended purpose, and this research …

Evaluation Of Anti-Vegf And Pan-Retinal Photocoagulation Laser Therapies In Proliferative Diabetic Retinopathy Patients: A Systematic Review, Senyum Indrakila, Namira Putri Imani, Aiman Hilmi Asaduddin, Muzakiya Lailatul Karima, Lygia Angelica Widjaja

Pharmaceutical Sciences and Research

Diabetic retinopathy is a complication of diabetes that is one of the top five causes of blindness in those over 50. The standard treatment is pan-retinal photocoagulation, which is effective but has established side effects. Anti-vascular endothelial growth factor (anti-VEGF) therapy becomes an alternative to avoid the side effects caused by laser therapy. This systematic review aims to know the effectiveness of anti-VEGF therapy compared to the pan-retinal photocoagulation laser therapy in patients with proliferative diabetic retinopathy. This review was carried out using a systematic review checklist on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The articles reviewed …

Utilization Of Pvp-Pla Combination In Fabricating Theophylline-Loaded Filament For 3d Printing With Immediate Release Behavior, Arief Kurniawan, Silvia Surini

Pharmaceutical Sciences and Research

Fused deposition modeling (FDM), known as a highly effective 3D printing technique, holds promise as an alternative approach to tablet manufacturing. While commonly employing thermoplastic polymers as starting materials, the integration of established pharmaceutical excipients remains unexplored. Polyvinyl pyrrolidone (PVP) is a frequently used excipient known for its potential to confer immediate-release properties to drugs. However, its suitability for extrusion is hindered by its thermal and melt-rheological properties. In contrast, polylactic acid (PLA), which has robust mechanical strength and thermal plasticity, was expected to overcome PVP’s limitations. This study aims to obtain drug-loaded filaments using the combination of PVP and …

Optimization Of 3,4-Dimethoxychalcone And Rutin Containing Gel With Simplex Lattice Design And In Vitro-In Vivo Test As A Sunscreen, Hana Anisa Fatimi, Abdul Karim Zulkarnain, Marlyn Dian Laksitorini

Pharmaceutical Sciences and Research

3,4-Dimethoxychalcone and rutin, a flavonoid that contains chromophore groups, can absorb UV light and thus can be developed as a sunscreen. The objective of this study was to determine the optimum formula of 3,4-dimethoxychalcone and rutin containing gel, evaluate its physical stability, and activity of 3,4-dimethoxychalcone and rutin gel as a sunscreen through in vitro and in vivo tests. HPMC, CMC-Na, and methylcellulose were formulated into a gel base to obtain good adhesion and a clear appearance gel. Simplex Lattice Design (SLD) with Design Expert software version 10 was utilized to determine the optimum gel formulation. UVA-PF protection, photostability with …

Optimization Of Lubrication And Compression Process Parameters Of Vitamin C Film-Coated Caplets, Ernestine Arianditha Pranasti, Ratna Annisa Utami, Yuda Prasetya Nugraha

Pharmaceutical Sciences and Research

Tablet production is a very intricate process influenced by numerous process variables or parameters. This study aimed to identify the critical processing variables that affect Critical Quality Attributes (CQAs) of vitamin C film-coated caplets utilizing a statistical experimental design. A two-level complete factorial design with two central points was used to examine the process parameters that posed the greatest risk to CQAs. The process variables investigated included mesh size and duration for the lubrication process, as well as speed and main thickness for compression. Statistical results showed that mesh number, lubrication time, and their interaction significantly affect flow rate, Hausner …

A Qualitative Exploration Of Exclusive Breastfeeding Practices Among Karen Ethnicity Mothers In Northern Thailand Remote Rural Areas, Wanchalerm Ritthimon, Aksara Thongprachum, Jukkrit Wungrath

Kesmas

Low exclusive breastfeeding rates among the Karen ethnic group in Northern Thailand's remote rural areas underscore the need to understand knowledge, attitudes, and social support to develop targeted interventions. This qualitative study examined exclusive breastfeeding practices and the factors influencing breastfeeding behavior among 14 Karen Ethnicity Mothers (KEMs) in Northern Thailand. A structured interview was used to collect the data, a triangular method to determine the data's validity, and a content analysis method to examine the data revealed seven themes and 14 subthemes. This study identified three key factors for successful breastfeeding: self-motivation, social support, and effective problem management, which …

Healthy Lifestyle Behaviors And Sociodemographic Characteristics Among Medical Students In Indonesia During The New Normal Era: A Cross-Sectional Study, Sharren Shera Vionnetta, Tommy Nugroho Tanumihardja, Kevin Kristian

Kesmas

This study aimed to identify medical students’ healthy lifestyle behaviors during the new normal era and to determine its relationship with sociodemographic factors, bearing in mind that, as future physicians and health role models, medical students play an important role in adopting and promoting healthy lifestyle behaviors to reduce the risk of future health problems as well as optimize communities’ health status. This cross-sectional study was conducted at the School of Medicine and Health Sciences of Universitas Katolik Indonesia Atma Jaya, with 111 medical students selected through stratified random sampling. Data were collected using sociodemographic characteristics (sex, residence, year of …